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Information

To be eligible for this account you must reside in one of the following North Carolina counties - Harnett, Wake, Johnston, Cumberland, Hoke, Moore, Lee, Chatham, Durham, Granville, Franklin, Nash, Wilson, Wayne or Sampson. Before proceeding, please confirm your eligibility below
Please select your county of residency:
By checking this box, I confirm that I am eligible for this account because I am a resident as I have indicated above:
Are you a new customer?:
Yes
No

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Personal Information

First Name: Middle Name: Last Name:
Date of Birth: Social Security Number: Driver's License Number:
State License Issue: Issue Date: Expiration Date:
Home Phone: Daytime Phone: Email:

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Contact Information

Choose the location you would like to complete your application: How would you prefer to be contacted?:
Phone
Mail
Email
When is the best time to arrange an appointment?:
Morning
Lunchtime
Afternoon

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Address Information

Residential Address (Not a P.O. Box): City: State:
Zip: Use residential address for mailing address:
Yes
No

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Joint Account Information

Number of Joint Owners on this Account:
0
1
2

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Joint Applicant #1

Relationship to Primary Applicant: First Name: Middle Name:
Last Name: Date of Birth: Social Security Number:
Drivers License Number: State Licensed Issued: Home Phone:
Work Phone: Residential Address: City:
State: Zip:

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Joint Applicant #2

Relationship to Primary Applicant: First Name: Middle Name:
Last Name: Date of Birth: Social Security Number:
Drivers License Number: State License Issued: Home Phone:
Work Phone: Residential Address: City:
State: Zip:

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Comments

First Federal Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.
I Agree: